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The prostate
is a small organ about the size of a walnut. It lies below the bladder
(where urine is stored) and surrounds the urethra (the tube that carries
urine from the bladder). The prostate makes a fluid that becomes part
of semen. Semen is the white fluid that contains sperm.
Prostate problems
are common in men 50 and older. Most can be treated successfully without
harming sexual function. A urologist (a specialist in diseases of the
urinary system) is the kind of doctor most qualified to diagnose and treat
many prostate problems.
Noncancerous Prostate
Problems
Acute prostatitis is a bacterial infection of the prostate. It
can occur in men at any age. Symptoms include fever, chills, and pain
in the lower back and between the legs. This problem also can make it
hard or painful to urinate. Doctors prescribe antibiotics for acute prostatitis
and recommend that the patient drink more liquids. Treatment is usually
successful.
Chronic prostatitis
is a prostate infection that comes back again and again. The symptoms
are similar to those of acute prostatitis except that there is usually
no fever. Also, the symptoms are usually milder in chronic prostatitis.
However, they can last a long time.
Chronic prostatitis
is hard to treat. Antibiotics often work when the infection is caused
by bacteria. But sometimes no disease causing bacteria can be found. In
some cases, it helps to massage the prostate to release fluids. Warm baths
also may bring relief. Chronic prostatitis clears up by itself in many
cases.
Benign prostatic
hypertrophy (BPH) is enlargement of the prostate. This condition is
common in older men. More than half of men in their 60’s have BPH. Among
men in their 70’s and 80’s, the figure may go as high as 90 percent.
An enlarged prostate
may eventually block the urethra and make it hard to urinate. Other common
symptoms are dribbling after urination and the urge to urinate often,
especially at night. In rare cases, the patient is unable to urinate.
A doctor usually
can detect an enlarged prostate by rectal exam. The doctor also may examine
the urethra, prostate, and bladder using a cytoscope, an instrument that
is inserted through the penis.
BPH Treatment
Choices
There are several different ways to treat BPH:
Watchful Waiting
is often chosen by men who are not bothered by symptoms of BPH. They have
no treatment but get regular checkups and wait to see whether or not the
condition gets worse.
Alpha blockers
are drugs that help relax muscles near the prostate and may relieve symptoms.
Side effects can include headaches. Also, these medicines sometimes make
people feel dizzy, lightheaded, or tired. Alpha blockers are new drugs,
so doctors do not know their long term effects. Some common alpha blockers
are doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin).
Finasteride
(Proscar) is a drug that inhibits the action of the male hormone testosterone.
It can shrink the prostate. Side effects of finasteride include declining
interest in sex, problems getting an erection, and problems with ejaculation.
Again, because it is new, doctors do not know its long-term effects.
Surgery
is the treatment most likely to relieve BPH symptoms. However, it also
has the most complications. Doctors use three kinds of surgery for BPH:
- Transurethral resection
of the prostate (TURP) is the most common. After the patient is given
anesthesia, the doctor inserts a special instrument into the urethra
through the penis. With the instrument, the doctor then removes part
of the prostate to lessen its obstruction.
- Transurethral incision
of the prostate (TUIP) may be used when the prostate is not too enlarged.
In this procedure, the doctor passes an instrument through the urethra
to make one or two small cuts in the prostate.
- Open surgery is
used when the prostate is very enlarged. In open surgery, the surgeon
makes an incision in the abdomen or between the scrotum and the anus
to remove prostate tissue.
Men should carefully
weigh the risks and benefits of each of these options. The Agency for
Health Care Policy and Research has designed a booklet to help in choosing
a treatment; call 800-358-9295 and ask for their free patient guide on
prostate enlargement.
Prostate Cancer
Prostate cancer is one of the most common forms of cancer among American
men. About 80 percent of all cases occur in men over 65. For unknown reasons,
prostate cancer is more common among African American men than white men.
In the early stages
of prostate cancer, the disease stays in the prostate and is not life
threatening. But without treatment, cancer can spread to other parts of
the body and eventually cause death. Some 40,000 men die every year from
prostate cancer that has spread.
Diagnosis.
To find the cause of prostate symptoms, the doctor takes a careful medical
history and performs a physical exam. The physical includes a digital
rectal exam, in which the doctor feels the prostate through the rectum.
Hard or lumpy areas may mean that cancer is present.
Some doctors also
recommend a blood test for a substance called prostate specific antigen
(PSA). PSA levels may be high in men who have prostate cancer or BPH.
However, the test is not always accurate. Researchers are studying changes
in PSA levels over time to learn whether the test may someday be useful
for early diagnosis of prostate cancer.
If a doctor suspects
prostate cancer, he or she may recommend a biopsy. This is a simple surgical
procedure in which a small piece of prostate tissue is removed with a
needle and examined under a microscope. If the biopsy shows prostate cancer,
other tests are done to determine the type of treatment needed.
Prostate Cancer
Treatment. Doctors have several ways to treat prostate cancer. The
choice depends on many factors, such as whether or not the cancer has
spread beyond the prostate, the patient’s age and general health, and
how the patient feels about the treatment options and their side effects.
Approaches to treatment include:
Watchful waiting
. Some men decide not to have treatment immediately if the cancer
is growing slowly and not causing symptoms. Instead, they have regular
checkups so they can be closely monitored by their doctor. Men who are
older or have another serious illness may choose this option.
Surgery
usually removes the entire prostate and surrounding tissues. This operation
is called a radical prostatectomy. In the past, impotence was a side effect
for nearly all men undergoing radical prostatectomy. But now, doctors
can preserve the nerves going to the penis so that men can have erections
after prostate removal.
Incontinence, the
inability to hold urine, is common for a time after radical surgery for
cancer. Most men regain urinary control within several weeks. A few continue
to have problems that require them to wear a device to collect urine.
Another kind of surgery
is a transurethral resection, which cuts cancer from the prostate
but does not take out the entire prostate. This operation is sometimes
done to relieve symptoms caused by the tumor before other treatment or
in men who cannot have a radical prostatectomy.
Radiation therapy
uses high energy rays to kill cancer cells and shrink tumors. It is often
used when cancer cells are found in more than one area. Impotence may
occur in men treated with radiation therapy.
Hormone therapy
uses various hormones to stop cancer cells from growing. It is used for
prostate cancer that has spread to distant parts of the body. Growth of
breast tissue is a common side effect of hormone therapy.
More detailed information
on the pros and cons of these treatment options is available from the
Cancer Information Service at 800-422-6237; ask for the prostate cancer
“PDQ for Patients.”
Protecting Yourself
The best protection against prostate problems is to have regular medical
checkups that include a careful prostate exam. See a doctor promptly if
symptoms occur such as:
- a frequent urge
to urinate,
- difficulty in urinating,
or
- dribbling of urine.
Regular checkups
are important even for men who have had surgery for BPH. BPH surgery does
not protect against prostate cancer because only part of the prostate
is removed. In all cases, the sooner a doctor finds a problem, the better
the chances that treatment will work.
Resources
Agency for Health
Care Policy and Research (AHCPR) Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295
Ask for the free
booklet called Treating Your Enlarged Prostate . It contains
detailed information on the pros and cons of different treatments for
BPH.
Cancer Information
Service (CIS)
National Cancer Institute
Building 31, Room 10A24
Bethesda, MD 20892
800-4-CANCER
CIS staff can answer
questions and mail free booklets about prostate cancer. The prostate cancer
“PDQ for Patients” contains detailed information on diagnosis and treatment.
Spanish speaking CIS staff are available during daytime hours.
National Kidney
and Urologic Diseases Information Clearinghouse
Box NKUDIC
Bethesda, MD 20892
301-468-6345
Ask for free materials
on BPH.
American Cancer
Society
1599 Clifton Road, NE
Atlanta, GA 30329
800-227-2345
Ask about their materials
on prostate cancer.
Prostate Health
Council
The American Foundation for Urologic Disease, Inc.
300 West Pratt Street
Suite 401
Baltimore, MD 21201
800-242-2383
Ask for free brochures
in English and Spanish on prostate disease and prostate cancer.
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